Psychosocial consequences of false-positive mammography among women attending breast cancer screening. Assessment, prediction, and coping.

One side-effect of breast cancer (BC) screening is a false-positive mammogram among healthy women. That is, finding(s) on a screening mammogram that lead to additional breast examinations but where the woman is eventually considered free from BC. There is evidence of short-term psychosocial consequences of false-positive BC screening. Regarding long-term consequences, research findings are inconsistent. Lack of validated condition-specific questionnaires targeting such consequences has been postulated as a potential reason for the inconsistencies. Therefore, the Consequences of Screening - Breast Cancer (COS-BC) questionnaire was developed in Denmark. However, before the COS-BC can be used for studying psychosocial consequences of false-positive BC screening across countries, it needs to be adapted and psychometrically (validity and reliability) tested therein. Furthermore, studies of prediction of long-term psychosocial consequences of false-positive BC screening and coping with such consequences might identify women at risk as well as interventions to prevent consequences of screening. Thus, the aim of this thesis was to validate measures of and study the psychosocial consequences of false-positive mammography among women in a Swedish breast cancer screening programme, and to explore how women cope with such a situation. Interviews with 26 women experiencing false-positive screening mammography (Paper I) provided support for the content validity of a Swedish version of the COS-BC; questionnaire items were generally found relevant, understandable, and covering the psychosocial consequences of false-positive BC screening. Psychometric tests (Paper II) of the COS-BC among 1442 women with false-positive or negative mammography demonstrated support for five COS-BC scales (Sense of dejection, Anxiety, Behavioural, Sleep, and Existential values) for cross-sectional and longitudinal group assessments. The remaining seven COS-BC scales should be used more cautiously. One year follow-up study (Paper III, framework) of 399 recalled women and 449 controls showed that women experience psychosocial consequences targeted by the COS-BC scales, except for breast self-examination consequences. Early recall for subsequent mammography demonstrated the strongest prediction of long-term consequences. Dissatisfaction with information at recall, worry about BC, lack of social support, and being foreign-born were also identified as potential predictors. Interviews with 13 women (Paper IV) experiencing psychosocial consequences of false-positive screening mammography revealed that coping with the situation implied a roller coaster of emotions and sense. Social support, sisterhood, and being professionally taken care of were identified as important aspects of coping with the perceived psychosocial consequences of false-positive BC screening (Paper IV). In conclusion, findings of this thesis confirm the occurrence of short-term psychosocial consequences and demonstrated long-term consequences of false-positive screening mammography among women. Early recall should be avoided and personalized information and communication could be of value in order to diminish the risk of long-term psychosocial consequences of false-positive BC screening. Further research is needed to investigate adequate communication styles, especially in order to face multicultural populations in the context of BC screening

Facilitators for and barriers to radiography research in public healthcare in Nordic countries

Introduction: It has been suggested that the future of diagnostic imaging relies on engagement in research and evidence-based practice. This implies a role transition from a clinical radiographer to a clinical radiographer-researcher. Clinical radiographers’ stimuli for engaging in research in Nordic countries are unknown. This study aimed to address this gap.Methods: Cross-sectional data collection via an online questionnaire on facilitators for and barriers to participation in radiography research was carried out among 507 clinical radiographers in public healthcare in the Nordic countries: Denmark, Finland, Norway and Sweden.Results: Support from colleagues (odds ratio [OR] 2.62) and other professionals (OR 2.74), and self-esteem in research skills (OR ≥ 2.21), were facilitators for radiography research. Lack of knowledge and skills to conduct research (OR 2.48) was revealed to hinder radiographers’ participation in research. The absence of a radiography research culture in the workplace explained non-participation in research (OR 1.75).Conclusion: This study revealed significant factors for clinical radiographers’ participation in research.Implications for practice: A strategy for establishing a radiography research culture in healthcare is proposed that is novel for the context. Management support for knowledge development and activity leading to inter-professional research projects across knowledge fields, provision of a radiography research lead and acknowledgement of radiography research among colleagues signify the establishment of the culture. These prerequisites might provide a paradigm change towards not only the symbiosis of a clinical radiographer and an autonomous researcher but also a partner who adds radiography research to evidence-based practice in diagnostic imaging.</p

How does image quality affect radiologists' perceived ability for image interpretation and lesion detection in digital mammography?

OBJECTIVES: To study how radiologists' perceived ability to interpret digital mammography (DM) images is affected by decreases in image quality. METHODS: One view from 45 DM cases (including 30 cancers) was degraded to six levels each of two acquisition-related issues (lower spatial resolution and increased quantum noise) and three post-processing-related issues (lower and higher contrast and increased correlated noise) seen during clinical evaluation of DM systems. The images were shown to fifteen breast screening radiologists from five countries. Aware of lesion location, the radiologists selected the most-degraded mammogram (indexed from 1 (reference) to 7 (most degraded)) they still felt was acceptable for interpretation. The median selected index, per degradation type, was calculated separately for calcification and soft tissue (including normal) cases. Using the two-sided, non-parametric Mann-Whitney test, the median indices for each case and degradation type were compared. RESULTS: Radiologists were not tolerant to increases (medians: 1.5 (calcifications) and 2 (soft tissue)) or decreases (median: 2, for both types) in contrast, but were more tolerant to correlated noise (median: 3, for both types). Increases in quantum noise were tolerated more for calcifications than for soft tissue cases (medians: 3 vs. 4, p = 0.02). Spatial resolution losses were considered less acceptable for calcification detection than for soft tissue cases (medians: 3.5 vs. 5, p = 0.001). CONCLUSIONS: Perceived ability of radiologists for image interpretation in DM was affected not only by image acquisition-related issues but also by image post-processing issues, and some of those issues affected calcification cases more than soft tissue cases. KEY POINTS: • Lower spatial resolution and increased quantum noise affected the radiologists' perceived ability to interpret calcification cases more than soft tissue lesion or normal cases. • Post-acquisition image processing-related effects, not only image acquisition-related effects, also impact the perceived ability of radiologists to interpret images and detect lesions. • In addition to current practices, post-acquisition image processing-related effects need to also be considered during the testing and evaluation of digital mammography systems

TO USE OR NOT USE PATIENT SHIELDING ON PREGNANT WOMEN UNDERGOING CT PULMONARY ANGIOGRAPHY : A PHANTOM STUDY

Pregnancy increases the risk of pulmonary embolism. Computed tomography pulmonary angiography (CTPA) is used for diagnosis. CT generates ionising radiation, and thus, abdominal shielding may be used. This phantom study investigated the effects of patient shielding and scan length reduction on the fetal and maternal ionising radiation dose from CTPA. The absorbed dose to the fetus was measured using thermoluminescent dosemeters. Estimated effective doses to the pregnant patient were based on the dose-length products. Shielding increased both the effective dose to the patient by 47% and the mean absorbed dose to the fetus (0.10 vs. 0.12 mGy; p < 0.001) compared with unshielded standard CTPA, as it affected the automatic exposure control. Shielded short CTPA marginally lowered only the mean fetal absorbed dose (0.03 vs. 0.02 mGy; p = 0.018). Shortening the scan reduced the fetal absorbed dose most effectively by 70% (0.10 vs. 0.03 mGy; p = 0.006), compared with the standard unshielded scan. Shielding modestly reduces fetal radiation dose but may compromise automatic exposure control, possibly increasing the maternal and fetal radiation dose. Shortening the scan is beneficial, assuming anatomical coverage is secured

Intra- and inter-rater reliability of compressed breast thickness, applied force, and pressure distribution in screening mammography

BackgroundEnsuring equivalent and reproducible breast compression between mammographic screening rounds is important for the diagnostic performance of mammography, yet the extent to which screening mammography positioning and compression is reproducible for the individual woman is unknown.PurposeTo investigate the intra- and inter-rater reliability of breast compression in screening mammography.Materials and MethodsEleven breast-healthy women participated in the study. Two experienced radiographers independently positioned and compressed the breasts of each participant in two projections—right craniocaudal and left mediolateral oblique—and at two time points. The spatial pressure distribution on the compressed breast was measured using a pressure sensor matrix. Applied force, compressed breast thickness, force in field of view, contact area, mean pressure, and center of mass (anterio-posterior and mediolateral axes) were measured. The reliabilities of the measures between the time points for each radiographer (intra-rater reliability) and between the radiographers (inter-rater reliability) were analyzed using the intraclass correlation coefficient (ICC).ResultsIntra- and inter-rater reliabilities from both projections demonstrated good to excellent ICCs (≥0.82) for compressed breast thickness, contact area, and anterio-posterior center of mass. The other measures produced ICCs that varied from poor (≤0.42) to excellent (≥0.93) between time points and between radiographers.ConclusionIntra- and inter-rater reliability of breast compression was consistently high for compressed breast thickness, contact area, and anterio-posterior center of mass but low for mediolateral center of mass and applied force. Further research is needed to establish objective and clinically useful parameters for the standardization of breast compression

Meeting Patient Information Needs Before Magnetic Resonance Imaging : Development and Evaluation of an Information Booklet

The aim was to develop and evaluate a preparatory information booklet for adult patients undergoing magnetic resonance imaging (MRI). The booklet was developed based on pertinent literature and clinical experience. After ethical approval, it was then evaluated qualitatively in 10 people who had received the booklet before their first ever MRI scan. All patients expressed the need for written preparatory information and seven had experienced prescan anxiety and discomfort. Participants found the booklet informative and easily understood, and expressed appreciation related to procedural, behavioral, and sensory information. A few minor misunderstandings were revealed. The impressions by previously MRI-naive participants in this study indicate that the information booklet was successful in providing procedural, behavioral, and sensory information. Minor booklet modifications should provide means to circumvent current misunderstandings. The process used to develop and evaluate the information booklet for this study illustrates an easily implemented strategy to meet patients' needs for preparatory information in clinical practice